Healthcare Provider Details

I. General information

NPI: 1205999885
Provider Name (Legal Business Name): LIQIANG WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MEDICAL CENTER BLVD 2ND FLOOR
WEBSTER TX
77598-4220
US

IV. Provider business mailing address

PO BOX 746559
ATLANTA GA
30374-6559
US

V. Phone/Fax

Practice location:
  • Phone: 281-338-3209
  • Fax: 281-338-3427
Mailing address:
  • Phone: 281-338-3208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberL5606
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: